Staging Regimen in Adult Spinal Deformity Surgery Impacts Functional Outcome, Complications & Total Hospital Days

2012-02-15 文章来源：www.aaos.org 点击量：1517 　　我要说

Classification:	Spine
Keywords:	Outcomes; Scoliosis / Deformities; Complications; Instrumentation
Author(s):	Hamid Hassanzadeh, MD, Baltimore, Maryland, United States Joseph P. Gjolaj, MD, Miami, Florida, United States Mostafa H. El Dafrawy, MD, Baltimore, Maryland, United States Amit Jain, BS, Portland, Oregon, United States David A. Cohen, MD, Baltimore, Maryland, United States Khaled M. Kebaish, MD, Baltimore, Maryland, United States
Abstract:	INTRODUCTIONThe effect of the staging regimen on the surgical outcome in patients undergoing combined anterior/posterior surgery for treatment of spinal deformity has not been studied. We hypothesize that in patients undergoing combined posterior and anterior procedures, delaying the second surgery (>21 days) is associated with less complications, shorter hospital stay and better outcome compared to performing both surgeries during the same hospitalization. METHODSRetrospective review of a prospectively collected data in 63 consecutive patients (50 F, 13 M) >40 years undergoing combined anterior and posterior fusions for spinal deformities. We compared the clinical and radiographic parameters, complications and functional outcome. All patients completed a minimum two years follow up. RESULTSTwenty-nine patients underwent posterior and anterior surgery during the same hospitalization (group I), average age 62 years (41-80). Thirty-four patients underwent their surgeries in two separate hospitalization, staged (>21 days)(group II) average age 60 ys (41-81). Group I and group II had similar preoperative ASA status 2.7 (2-3) vs. 2.7 (2-4) and number of previous surgeries 1.03 (0-2) vs. 1.08 (0-6). The average levels fused were 9(4-16) posterior & 1.6(1-3) anterior for group I and 9.5 (5-17) and 1.03 (1-2) for the group II. The average time between the two stages was seven days (0-15) for group I, and 38 days (22-61) for group II. Average operative time; two stages combined was similar in both groups; 624 min (430-820) for group I & 623 min (505-770) for group II. The average combined hospital days was lower for group II, 12 days (6-44) compared to group I, 14 days (7-70). The combined total estimated blood loss, 4L (1.8-10.1L) was lower for the group II than the group I with 4.5L (1.90-8.75L). Preoperative SRS-24 and ODI scores were similar in the two groups, but significantly better in group II compared to group I at six weeks and at final follow up, respectively (Table 1). DISCUSSION AND CONCLUSIONWhen combined anterior and posterior surgery is indicated, staging the two procedures in two different hospitalizations (>21 days) decreased total hospital days and complications with significantly improved outcome. Staging combined anterior and porterior surgery in adult spinal deformity should be considered whenever possible, as it may decrease cost, lessen complications and improve outcome

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